HomeMy WebLinkAboutAgenda - 02-21-2017 - 6-h - Health Department Fee Schedule Changes 1
ORANGE COUNTY
BOARD OF COMMISSIONERS
ACTION AGENDA ITEM ABSTRACT
Meeting Date: February 21, 2017
Action Agenda
Item No. 6-h
SUBJECT: Health Department Fee Schedule Changes
DEPARTMENT: Health
ATTACHMENT(S): INFORMATION CONTACT:
Dr. Colleen Bridger, 919-245-2412
Duke Hexavalent Chromium Study Rebecca Crawford, 919-245-2414
PURPOSE: To adopt and revise multiple Dental Health and Environmental Health fees
approved by the Board of Health at its January 25, 2017 meeting.
BACKGROUND: The Health Department reviews fee schedules on an annual basis through
the budget approval process. However, multiple procedures in Dental Health and labs in
Environmental Health have increased in frequency of use this fiscal year and it is necessary to
add them to the fee schedule in an effort to recover costs. The proposed changes are detailed
below:
FINANCIAL IMPACT:
Dental Health
Dental Health requests the addition of two new fees for Provisional Splinting, intracoronal and
extracoronal. These procedures have been used more frequently this fiscal year and are costly
due to the supplies necessary to perform the procedures. Dental Health estimates performing 2-
4 of each of these procedures per month for the remainder of FY 2016-17. The fees were
determined based on the Delta Dental and Cigna reimbursement rates for these procedures as
the Usual, Customary, and Reasonable rates for this area for these fees were much higher
($252 and $316 respectively) and viewed as cost prohibitive for 100% payers on the sliding fee
scale. The sliding scale is applicable to all dental fees.
Name of Fee 2016-17 2016-17 Proposed 2016-17 Budget
Current Fee Fee Impact
Provisional Splinting, intracoronal $0 $115 $2,070
Provisional Splinting, extracoronal $0 $115 $2,070
2
Environmental Health
Environmental Health requests to add two additional fees for well water testing for Hexavalent
chromium and Coal Ash following the release of the October 2016 study by Duke University.
This study noted that Hexavalent Chromium occurs naturally in the Piedmont area of NC with a
higher prevalence than previously thought. Environmental Health has had seven requests for
Hexavalent chromium tests and two requests for Coal Ash panels as of December 2016 and
anticipates sending off six samples each for these tests for the remainder of the fiscal year. The
cost of the fees were determined based on the cost for sample bottles, shipping, and staff
collection time. Environmental Health fees are not administered based on a sliding fee scale.
Name of Fee 2016-17 2016-17 Proposed 2016-17 Budget
Current Fee Fee Impact
Hexavalent chromium $0 $90 $540
Coal Ash Inorganic Panel $0 $110 $660
SOCIAL JUSTICE IMPACT: The following Orange County Social Justice Goal is applicable to
this agenda item:
• GOAL: ENSURE ECONOMIC SELF-SUFFICIENCY
The creation and preservation of infrastructure, policies, programs and funding necessary
for residents to provide shelter, food, clothing and medical care for themselves and their
dependents.
RECOMMENDATION(S): The Manager recommends that the Board approve the revised fees
as requested.
Hexavalent chromium is widespread in North Carolina wells but not linked to coal ash -- Sciellag➢di1yf 4
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SciE .flc:eD ail'I
Your source for the latest research news
Hexavalent chromium is widespread in North Carolina wells
but not linked to coal ash
Date: October 26, 2016
Source: Duke University
Summary: Hexavalent chromium, a carcinogen made famous by the movie Erin Brockovich, is far
more abundant in drinking water wells in North Carolina than previously thought, a new
study finds.
FULL STORY
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Hexavalent chromium, a carcinogen made famous by the movie Erin
Brockovich, is far more abundant in drinking water wells in North Carolina than
previously thought, a new Duke University study finds.
The contamination doesn't, however, stem from leaking coal ash ponds as many people feared after
state officials tested wells near coal plants last year and detected potentially harmful levels of
hexavalent chromium in the water.
Instead, its caused by the natural leaching of mostly volcanic rocks in aquifers across the Piedmont
region.
"About 90 percent of the wells we sampled had detectable levels of hexavalent chromium, and in many
cases the contamination is well above recommended levels for safe drinking water. But our analysis
clearly shows it is derived from natural sources, not coal ash," said Avner Vengosh, professor of
geochemistry and water quality at Duke's Nicholas School of the Environment.
https://www.sciencedaily.com/releases/2016/10/161026111400.htm 12/16/2016
Hexavalent chromium is widespread in North Carolina wells but not linked to coal ash -- SciellaglAi1yf 4
4
"This doesn't mean it poses less of a threat,"Vengosh stressed. "If anything, because the
contamination stems from water-rock interactions that are common across the Piedmont region, people
in a much larger geographic area may be at risk. This is not limited only to wells near coal ash ponds.
"The bottom line is that we need to protect the health of North Carolinians from the naturally occurring
threat of hexavalent chromium, while also protecting them from harmful contaminants such as arsenic
and selenium, which our previous research has shown do derive from leaking coal ash ponds,"
Vengosh said. "The impact of leaking coal ash ponds on water resources is still a major environmental
issue."
To conduct the new study, the researchers collected groundwater samples from 376 wells located both
close to and far from coal ash ponds across the Piedmont region of central North Carolina. Using
forensic geochemical tracers, they analyzed each sample for a wide range of inorganic chemicals,
including hexavalent chromium.
The tracers, which were developed by Vengosh and his team, allowed the scientists to identify the
geochemical fingerprints of contaminants in the groundwater and trace each contaminant back to its
source.
"Our analysis showed that groundwater samples with high levels of hexavalent chromium have very
different geochemical fingerprints than what we see in groundwater contaminated from leaking coal ash
ponds,"Vengosh said.
"This, combined with the wide geographic distribution of samples containing elevated hexavalent
chromium-- regardless of proximity to a coal ash pond -- points to the natural leaching of chromium
from aquifer rocks in certain Piedmont geological formations," he said.
Piedmont formations with volcanic rocks are common across the southeastern United States and other
areas worldwide, Vengosh noted, so millions of people in regions outside North Carolina with similar
aquifers may be exposed to hexavalent chromium without knowing it.
The Duke team published its findings October 26 in the peer-reviewed journal Environmental Science
and Technology Letters.
In 2015, water-quality officials in North Carolina issued temporary "do not drink" recommendations to
residents living near coal-burning plants after tests detected potentially harmful levels of hexavalent
chromium in their well water samples. Because elevated levels of chromium typically occur in coal ash,
many people assumed the contamination was linked to the coal ash ponds.
Vengosh's team's study is the first to show otherwise.
The current drinking water standard for chromium in the United States is 100 parts per billion. This is
based on an assumption that most chromium contained in drinking water is composed of a less toxic
form known as trivalent chromium. Only California has set a statewide standard of 10 parts per billion
for the much more toxic hexavalent form.
Vengosh hopes his study's findings will lead more states to establish hexavalent chromium standards of
their own. "One of the most striking outcomes of this study is that it shows the concentration of
hexavalent chromium in groundwater is almost identical to the concentration of total dissolved
https://www.sciencedaily.com/releases/2016/10/161026111400.htm 12/16/2016
Hexavalent chromium is widespread in North Carolina wells but not linked to coal ash -- Sciellag➢Si1yf 4
5
chromium, measured by a totally different technique" he said. "That means when you will find chromium
in groundwater, it is actually composed of its toxic form of hexavalent chromium, not the less toxic
trivalent form."
Story Source:
Materials provided by Duke University. Note: Content may be edited for style and length.
Journal Reference:
1. Avner Vengosh, Rachel Coyte, Jonathan Karr, Jennifer S. Harkness, Andrew J. Kondash, Laura S.
Ruhl, Rose B. Merola, Gary S. Dywer. Origin of Hexavalent Chromium in Drinking Water Wells
from the Piedmont Aquifers of North Carolina. Environmental Science & Technology Letters,
2016; DOI: 10.1021/acs.estlett.6b00342
Cite This Page:
MLA APA Chicago
Duke University. "Hexavalent chromium is widespread in North Carolina wells but not linked to coal
ash." ScienceDaily. ScienceDaily, 26 October 2016.
<www.sciencedaily.com/releases/2016/10/161026111400.htm>.
https://www.sciencedaily.com/releases/2016/10/161026111400.htm 12/16/2016